Chaengsuthiworawat Papawadee, Thampongsa Tharin, Thamjamrassri Thanyalak, Pisitsak Chawika
Department of Emergency Medicine, Chonburi Hospital, Chonburi, Thailand.
Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Can J Anaesth. 2025 Jun;72(6):966-974. doi: 10.1007/s12630-025-02977-5. Epub 2025 Jun 9.
PURPOSE: Acute kidney injury (AKI) is a common complication of sepsis. AKI is associated with increased morbidity and mortality. Studies show that dexmedetomidine has a protective effect against AKI. We sought to evaluate the association between dexmedetomidine administration and AKI in patients with sepsis. METHODS: We conducted a retrospective cohort study of 331 adult patients with sepsis. We divided patients into two groups: patients who received an infusion of dexmedetomidine of ≥ 0.2 µg·kg·hr for > 6 hr within 72 hr of sepsis diagnosis (the dexmedetomidine group; N = 73) and patients who did not receive a dexmedetomidine infusion (the nondexmedetomidine group; N = 258). The primary outcome was the incidence of AKI within seven days, defined by the Kidney Disease Improving Global Outcomes (KDIGO) criteria. We analyzed our results using multivariable logistic regression models including 1) the entire cohort (331 patients) or 2) a 1:1 propensity-score-matched cohort (73 patients per group). RESULTS: Acute kidney injury was diagnosed in 190/331 (57.4%) patients. The incidence of AKI was not different between the dexmedetomidine group and the nondexmedetomidine group in both the entire cohort (54.8% vs 58.1%; P = 0.61) and the propensity-matched cohort (54.7% vs 63.0%; P = 0.31). Additionally, there were no significant differences between groups in the incidence of renal replacement therapy (10.9% vs 13.6%; P = 0.61) and 30-day mortality (32.8% vs 24.6%; P = 0.27). We observed a statistically significant interaction between patient age > 65 yr and reduced odds of developing AKI in patients who received dexmedetomidine (adjusted odds ratio, 0.25; 95% confidence interval, 0.07 to 0.90; P = 0.03). CONCLUSIONS: While there was no association between dexmedetomidine administration and AKI in our overall cohort of patients with sepsis, we observed reduced odds of developing AKI in older patients (aged > 65 yr) who received dexmedetomidine. Further research is needed to confirm that dexmedetomidine has a protective effect against AKI in this patient population.
目的：急性肾损伤（AKI）是脓毒症的常见并发症。AKI与发病率和死亡率增加相关。研究表明，右美托咪定对AKI具有保护作用。我们旨在评估脓毒症患者使用右美托咪定与AKI之间的关联。 方法：我们对331例成年脓毒症患者进行了一项回顾性队列研究。我们将患者分为两组：在脓毒症诊断后72小时内接受≥0.2µg·kg·hr的右美托咪定输注超过6小时的患者（右美托咪定组；N = 73）和未接受右美托咪定输注的患者（非右美托咪定组；N = 258）。主要结局是7天内AKI的发生率，根据改善全球肾脏病预后组织（KDIGO）标准定义。我们使用多变量逻辑回归模型分析结果，包括1）整个队列（331例患者）或2）1:1倾向评分匹配队列（每组73例患者）。 结果：331例患者中有190例（57.4%）被诊断为急性肾损伤。在整个队列（54.8%对58.1%；P = 0.61）和倾向匹配队列（54.7%对63.0%；P = 0.31）中，右美托咪定组和非右美托咪定组的AKI发生率无差异。此外，两组在肾脏替代治疗发生率（10.9%对13.6%；P = 0.61）和30天死亡率（32.8%对24.6%；P = 0.27）方面也无显著差异。我们观察到年龄>65岁的患者与接受右美托咪定的患者发生AKI的几率降低之间存在统计学上的显著交互作用（调整后的优势比，0.25；95%置信区间，0.07至0.90；P = 0.03）。 结论：虽然在我们的总体脓毒症患者队列中，右美托咪定的使用与AKI之间没有关联，但我们观察到接受右美托咪定的老年患者（年龄>65岁）发生AKI的几率降低。需要进一步研究来证实右美托咪定对该患者群体的AKI具有保护作用。
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